La Bella of Freeburg

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to prevent falls by failing to maintain working status of chair pad alarms for 1 (R2) of three residents reviewed for accidents.Findings include:R2's admission record documents an admission date of 03/10/25 with diagnoses including: chronic kidney disease, shortness of breath, anxiety disorder, torsades de pointes, sepsis, atrial fibrillation, heart failure, acute respiratory failure with hypoxia, restlessness and agitation, muscle weakness, unsteadiness on feet, cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery, and osteoarthritis. R2's MDS dated [DATE] documents a BIMS score of 04 indicating severely impaired.R2's care plan documents a focus area of: R2 is at risk for falls relating to history of falls upon admit, weakness with an intervention of: chair pad alarm, bed pad alarm dated 04/07/25 and re-education to staff to check alarm and that functioning properly before exit room dated 08/08/25.R2's incident note…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to provide the services of a registered professional nurse at least 8 consecutive hours a day, 7 days a week. This failure has the potential to affect all residents in the facility.Findings include:Facility's Nurses Schedule 8/22/25 through 11/27/25 does not document that a Registered Nurse worked consecutive 8 hours on 8/30/25, 9/10/25, 10/12/25, 11/5/25, and 11/22/25.Facility assessment dated [DATE] documents that the facility requires the services of Licensed nurses providing direct care for day shift - 4, Evening shift - 3 or 4, Night shift - 2-3. The Facility Assessment documents that the facility requires Licensed Nurses (LN): RN (Registered Nurse), LPN (Licensed Practical Nurse), LVN (Licensed Vocational Nurse) providing direct care of 1 - DON, 1 - ADON, 2-3 - RNs, 8-10 - LPN daily.On 11/25/2025 at 12:34 PM, V6, Human Resources (HR) stated they could not find any RN coverage for the dates 8/30/25, 9/10/25, 11/15/25, and 11/22/25.CMS form 671 dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to notify 1 (R2) of 5 resident representatives of significant changes in status which were reviewed for change in status in the sample of 8. This past non-compliance occurred 5/10/25 to 5/23/25. Findings include: R2's undated Face Sheet documents an admission date of 12/31/24 with pertinent diagnosis of Cerebral Infarction due to Unspecified Occlusion or Stenosis of left Posterior Cerebral Artery and Facial Weakness. R2's Minimum Data Set (MDS) dated [DATE] that R2 is severely cognitively impaired. R2's Practitioner's Order for Life Sustaining Treatment (POLST) dated 12/31/2024 documents that V9 daughter of R2 is designated as agent of power of attorney for healthcare, R2's Nurse's Progress notes dated 5/10/25 documents a late entry: (R2) mistakenly sent to emergency room (ER) due to low blood pressure and low O2 sats. (V25) Medical Director (MD) and (V9) Power of Attorney (POA) were notified. On 5/27/25 at 11:46 AM V9, R2's daughter and power of attorney…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based interview and record review the facility failed to ensure that 1 of 3 (R2) residents or their representative reviewed for hospital transfer received sufficient preparation for transfer to the hospital in the sample of 8. This past non-compliance occurred 5/10/25 to 5/23/25. Findings include: R2's undated Face Sheet documents an admission date of 12/31/24 with pertinent diagnosis of Cerebral Infarction due to Unspecified Occlusion or Stenosis of left Posterior Cerebral Artery and Facial Weakness. R2's Minimum Data Set (MDS) dated [DATE] that R2 is severely impaired. R2's Practitioner's Order for Life Sustaining Treatment (POLST) dated 12/31/2024 documents that V9 daughter of R2 is designated as agent of power of attorney for healthcare. On 5/27/25 at 11:46 AM V9, daughter of R2 stated she was not made aware her mother (R2) had mistakenly been sent to the hospital. (R2) cannot speak for herself and is not cognizant, therefore the facility did not have (R2's) or her (V9) consent to send (R2) to the hospital.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review the facility failed to ensure food was stored and prepared in a manner which prevents potential contamination. This has the potential to affect all 99 residents living in the facility. Findings include: On 8/27/2024 at 9:13 AM, tour of the facility was conducted. In the kitchen in the sink were 5 large industrial clear bags of frozen chicken. Water was running over one bag, but the other four bags did not have any water running on them. The temperature of the water was taken with a calibrated metal thermometer and the water was 100.0 degrees Fahrenheit (F). There was not a stopper in the sink and the water was running straight down into the drain. The frozen chicken was not submerged in the water. There was about ½ of water in the sink with the water running. Not all of the chicken was in water. On 8/27/2024 at 9:22 AM, in the walk-in refrigerator was a moving tray and on the tray on the top shelves were small clear plastic cups with an orange substance inside of the cups. The orange cups were not covered and were exposed in the air…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the Facility failed to ensure proper infection control guidelines were being followed for 6 of 22 residents (R20, R48, R28, R38, R42 and R60) reviewed for infection control in the sample of 41. Findings include: 1. On 8/27/2024 at 12:11 PM, V39, Certified Nursing Assistant (CNA) was feeding (R42). V39 was wearing a mask and was resting her elbows on the dining room table and both of her hands were on her cheeks. She then proceeded to feed R42 without disinfecting and/or washing her hands. On 8/27/2024 at 12:15 PM, V39, reached over the table and touched R42's bib and then proceeded to feed another resident without disinfecting and/or washing her hands. Then after touching her face again she proceeded to feed R42 without disinfection and /or washing her hands. 2. On 8/30/2024 at 10:33 AM, wound care was provided by V35, Licensed Practical Nurse (LPN). R48's door had a sign on the door documenting EBP (Enhanced Barrier Precautions) and instructed staff to wear PPE (Personal Protective Equipment) including mask, gloves and gowns. V35…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to report an injury of unknown origin for 1 of 2 residents (R23) reviewed for abuse in the sample of 41. Findings include: On 8/27/24 at 11:00 AM, V1, Administrator stated she does not have any investigations of injuries of unknown origin or abuse investigations. R23's Face Sheet documents her diagnoses as Generalized Anxiety, Major Depressive Disorder, Dementia in Other Diseases Classified Elsewhere, Unspecified Severity, with Other Behavioral Disturbances, Unsteadiness on Feet, and Muscle Weakness. R23's Minimum Data Set (MDS) dated [DATE] documents she is severely cognitively impaired and is dependent on staff for toileting, dressing, turning and positioning, and transfers. R23's undated Care Plan documents, Skin Integrity with goal of, The skin will remain intact. Interventions include, Continue with A&D Ointment or zinc oxide daily and as needed for protection, encourage good nutrition and hydration in order to promote healthier skin, monitor for…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY The facility failed to ensure all bruises of unknown origin were thoroughly investigated for 1 of 3 residents (R48) reviewed for bruises of unknown origin in the sample of 41. Findings include: R48's Physician Order Sheet (POS for August 2024) documents a diagnosis of Major Depression disorder, severe with psychotic symptoms, pressure ulcer of left heel, Alzheimer disease, dementia in other disease classified elsewhere, unspecified severity, with other behavioral disturbances, psychotic disorder with delusions due to known physiological condition, and anxiety and bilateral primary osteoarthritis of hip. R48's Minimum Data Set (MDS) dated [DATE] documents she is severely impaired for cognition for activities of daily living, she has impairments on both sides, she uses a manual wheelchair. She is dependent on staff for eating, oral hygiene, toileting, showering/bathing, upper and lower body dressing, putting on/taking off footwear and personal hygiene, Rolling from left to right, sit to stand, chair to bed, toilet…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to implement a system in which staff immediately report allegations of abuse and injuries of unknown origin to the Administrator and State Agency. This has the potential to affect all 96 residents residing in the facility. Findings include: 1.R2's admission Record Form, dated 12/3/23, documented R2 was admitted to the facility on [DATE] with diagnosis of dementia, anxiety disorder, age-related nuclear cataract, essential hypertension, dissection of unspecified site of aorta, thoracic aortic aneurysm (without rupture), and fracture of unspecified part of neck of right femur. R2's admission record form documented a diagnosis (with an onset dated 8/9/23) of acute embolism and thrombosis of another specified deep vein of right lower. R2's admission record form documented diagnosis (with onset dates of 8/17/23) of unspecified fracture of lower end of right femur, subsequent encounter for closed fracture with routine healing, unspecified severe protein-calorie…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to properly investigate allegations of verbal and physical abuse and injuries of unknown origins for 4 of 4 (R1, R2, R16, R17) residents reviewed for accidents and abuse in a sample of 17. This failure has the potential to affect all 96 residents residing in the facility. Findings include: 1. R2's admission record form, dated 12/3/23, documented R2 was admitted to the facility on [DATE] with diagnosis of dementia, anxiety disorder, age-related nuclear cataract, essential hypertension, dissection of unspecified site of aorta, thoracic aortic aneurysm (without rupture), and fracture of unspecified part of neck of right femur. R2's admission record form documented a diagnosis (with an onset dated 8/9/23) of acute embolism and thrombosis of other specified deep vein of right lower. R2's admission record form documented diagnosis (with onset dates of 8/17/23) of unspecified fracture of lower end of right femur, subsequent encounter for closed fracture with…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the Facility failed to store, prepare, and serve food in a manner which prevents potential contamination. This has the potential to affect all 96 residents living in the Facility. Findings include: On 9/19/23 at 8:44 AM V10, dishwasher, was spraying dirty dishes in the third compartment of the three-compartment sink. The spray resulted in drops of water on the floor approximately three feet away and on the arm of the surveyor standing next to a shelf. The shelf held a container of clean eating utensils and two trays of mandarin oranges that were not covered, potentially allowing a point of entry for the rinse water. On 9/19/23 at 8:47 AM the beverage refrigerator, next to the steam table contained ten individual cups of chocolate pudding that were not covered, labeled, or dated. On 9/19/23 at 8:48 AM the first compartment of the three-compartment sink held a crate with nutritional supplements. There was a pair of dishwashing gloves draped across the faucet that were in contact with the crate. The second compartment of the sink held…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to protect the privacy and confidentiality of 4 of 6 residents (R5, R31, R70 and R82) in the sample of 42, by displaying identifying information that includes their names, date of birth s, room location, care needs and code status in plain view of the public hanging over the residents' beds. Findings include: 1. R5's Face Sheet undated documents, R5's diagnosis as Severe Protein Malnutrition, Unspecified Dementia, Unspecified Severity without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance and Anxiety. R5's Minimum Data Set, (MDS), dated [DATE] documents, R5's Cognitive Skills for Daily Decision Making as severely impaired. R5 is Total Dependent for bed mobility, transfer, locomotion on and off unit, eating, personal hygiene and toilet use. Extensive Assistance is required for dressing. R5's Visual Bedside [NAME] Report, undated documents, R5's identifying information, (i.e., name. d.o.b. and room location) and admission date,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, and observation the facility failed to provide appropriate catheter care for one of four residents (R150) reviewed for catheter care in the sample of 42. Findings Include: R150's Care Plan dated 9/15/23 documents, resident (R150) has a urinary catheter. Interventions catheter care and treatment per current MD, (Medical Doctor), Observe/record/report to MD for signs and symptoms of UTI, (Urinary Tract Infection), which are pain, burning, blood-tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temperature, urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, and change in eating patterns. R150's admission summary dated [DATE] documents, R150 was placed on contact isolation for MRSA, (Methicillin Resistant Staph Aureus), and penile drainage. R150's Genital culture dated 9/13/23 documents, MRSA, (Methicillin-resistant Staphylococcus aureus). R150's Physician Order Sheet, (POS), dated 9/19/23…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.